New Diagnoses Spur Behavior Change in Older Adults

Action Points

Explain to patients that this study suggests that a new adverse diagnosis may provide motivation for older adults to make lifestyle changes, such as weight loss and smoking cessation.

Note that the findings were based on a retrospective review of data, not a randomized controlled clinical trial.

NEW HAVEN, Conn., Feb. 9 -- A new diagnosis of a chronic illness may serve as a wake-up call for lifestyle changes in older adults, according to a study of health and retirement.

New diagnoses tripled the likelihood of smoking cessation in a group of middle-age and older adults, Patricia Keenan, Ph.D., of Yale, reported in the Feb. 9 issue of Archives of Internal Medicine.

Overall, overweight and obese patients did not lose any weight. However, a diagnosis of lung disease, heart disease, or diabetes spurred weight loss of two to three pounds.

Multiple diagnoses led to bigger lifestyle changes.

"Targeting individuals with recent new diagnoses may be particularly effective in middle-aged and older individuals, who are increasingly likely to receive a major diagnosis or to be hospitalized as they age," Dr. Keenan said.

"Individuals with new adverse health events are accessible through contact with the healthcare system or through the Internet or other written information about their disease, and this study suggests that they are more motivated to change health habits," she added.

Several factors have suggested that adverse health events may increase patients' receptiveness to behavior changes.

People are living longer after the onset of acute and chronic conditions

Aging Baby Boomers will place greater demands on the healthcare system

Secondary prevention may be particularly relevant to middle-aged or older adults because they have an increased risk of adverse health events.

To determine whether adverse diagnoses stimulate behavior change, Dr. Keenan reviewed data from a series of surveys completed by middle-age and older adults enrolled in the Health and Retirement Study. Participants completed the surveys every other year from 1992 to 2000. Dr. Keenan's analysis included 20,221 overweight and obese people younger than 75 and 7,764 smokers.

During the follow-up period, 13% of smokers had one or more major diagnoses: stroke, cancer, lung disease, heart disease, and diabetes. Additionally, 8% of overweight individuals had diagnoses of lung disease, heart disease, and diabetes.

Overall, 18% of smokers kicked the habit during the follow-up period. In a multivariate analysis, Dr. Keenan found that smokers were more than three times as likely to quit after an adverse diagnosis, compared with smokers who had none of the major diagnoses (OR 3.17, 95% CI 2.62 to 3.84). Patients with more than one of the major diagnoses were six times as likely to quit smoking.

Among the overweight group, an adverse diagnosis was associated with a 0.35 kg/m2 reduction in body mass index, compared with overweight individuals who had none of the major diagnoses (95% CI -0.52 to -0.18). Multiple diagnoses almost doubled the magnitude of BMI reduction to 0.64 kg/m2.

"The results of the present study suggest that across a range of acute and chronic conditions, new diagnoses can serve as a window of opportunity that prompts individuals to change health habits, in particular, to quit smoking," Dr. Keenan concluded.

In an accompanying editorial, Sherry Pagoto, Ph.D., and Judith Ockene, Ph.D., of the University of Massachusetts in Worcester, said that physician encouragement and access to healthcare services have key roles in effecting behavior change in middle-aged and older adults.

They pointed out however that "still unknown is the degree to which the Keenan findings reflect physician counseling patterns. Rates of physician counseling for smoking cessation (22%) and weight loss (24%) are generally low; however, they tend to be higher for patients who receive smoking- and obesity-related diagnoses."

"Identifying windows of opportunity for patient receptiveness to lifestyle changes could help guide physicians as to when counseling will have the greatest effect," they said.

"However, the effect of physician advice might only be as good as the availability of supportive services to which patients can be referred for specialized preventive care. Our healthcare system is incomplete to the extent that patients and healthy subjects do not have affordable access to evidence-based preventive services."

Reviewed by Zalman S. Agus, MD Emeritus Professor University of Pennsylvania School of Medicine

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